This inspection took place on 16 October 2018 and was unannounced.

Seven Hills Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Seven Hills Nursing Home can accommodate up to 28 people who require accommodation and nursing or personal care. The home consists of one adapted building across three floors. At the time of our inspection there were 28 people living in the home.

Our last inspection of Seven Hills Nursing Home took place on 14 August 2017. We rated the service requires improvement. We found there was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; person-centred care. This was because people’s care plans did not always reflect their needs and did not always include their preferences so they were not person-centred. In addition, we found no evidence of activities taking place in the home so people were not offered social stimulation.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the service to at least good. At this inspection we found sufficient improvements had been made to meet the requirements of Regulation 9 and the service had improved to good.

There was a registered manager employed at Seven Hills Nursing Home. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Relatives told us they believed their family member was safe living at Seven Hills Nursing Home. There were enough staff available to meet people's needs in a timely way and to keep people safe. Staff had been trained in how to safeguard vulnerable adults and they had a good understanding of their responsibility to protect people from harm.

People received their medicines as prescribed from staff who had been trained in medicines management. We have made a recommendation about the provider’s policies and procedures for medicines management.

People told us the staff were kind and caring. During this inspection we observed staff treat people with kindness, dignity and respect.

Staff received a range of training which the provider considered to be mandatory. Staff told us they were happy with the training they received and felt it supported them in their roles. Staff were supported by the management team through supervisions and appraisals.

People were asked for consent before care was provided to them. Where people lacked capacity to make certain decisions for themselves, their care records showed decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

The service worked closely with community health professionals to support people with their health needs. People's care records evidenced they received medical attention when they needed it, to promote their health.

People were supported to eat a varied diet that met their nutritional requirements. The service had protected mealtimes where all staff supported the provision of the meal service.

A range of individual and group activities were provided within the home and in the local community. Staff clearly knew people’s likes and dislikes and supported them to take part in activities of their preference.

People’s needs were assessed and the support they needed from staff was clearly recorded in their care plan. The home had recently started using a new electroni

Seven Hills Nursing Home is a 28 bedded home offering nursing and residential care for older adults, some of whom are living with dementia. At the time of our inspection there were 26 people living there. The home is situated in South Yorkshire and within easy reach of Sheffield city centre and public transport links.

At the time of our inspection the home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection at Seven Hills Nursing Home took place on 19 October 2015. The home was rated Good overall. We identified a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Need for consent. The registered provider sent an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of this regulation.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Seven Hills Nursing Home on our website at ‘www.cqc.org.uk’.

This inspection took place on 14 August 2017 and was unannounced. This meant the people who lived at Seven Hills Nursing Home and the staff who worked there did not know we were coming.

We were not able to talk with some people living at the home due to their complex conditions, However, we observed staff interacting with them. Visiting relatives spoke positively of their experiences at Seven Hills Nursing Home. They told us they thought that individuals living there were happy, felt safe and were respected.

We found systems were in place to make sure people received their medicines safely so their health needs were looked after. There were protocols in place for medicines prescribed on an ‘as and when’ required basis (PRN). This meant staff knew when PRN medicine was required and for what.

Staff recruitment procedures ensured people’s safety was promoted. The provider ensured pre-employment checks were carried out prior to new staff commencing employment.

Sufficient numbers of staff were provided to meet people’s needs. We saw that staff responded in a timely way when people required assistance.

Staff were provided with relevant training which gave then the skills they needed to undertake their role. We found that not all staff were receiving supervision and appraisal at the frequency stated in the service’s own procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice. The service was working within the principles of the Mental Capacity Act 2005. However, the system for monitoring standard authorisations for deprivation of liberty or pending applications was not always effective.

People’s individual needs were not currently met by the design, adaptation and decoration of the service. There were no tactile pictures for people to look at and touch and the walls were bare in many areas.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account individual dietary needs and preferences. This meant people’s health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

We looked at care records and found they contained

Seven Hills Nursing Home is a 28 bedded home offering nursing and residential care for older adults, some of whom are living with dementia. At the time of our inspection there were 25 people living there. It is situated in South Yorkshire and within easy reach of Sheffield city centre and public transport links.

Our last inspection of Seven Hills Nursing Home was on 6 August 2013 and the service was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 19 October 2015 and was unannounced. This means the people who lived at Seven Hills Nursing Home and the staff who worked there did not know we were coming.

There was a manager at the service who was registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they liked living at Seven Hills Nursing Home and staff told us they enjoyed working there.

We found systems were in place to make sure people received their medication safely.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Enough staff were employed to keep people safe, although there were only limited activities available to people living at Seven Hills Nursing Home. What was available was dependent on how busy care staff were.

Staff were provided with relevant training and support to make sure they had the right skills and knowledge for their role.

People were treated with dignity and respect. We saw that staff were caring and communicated well with people living at Seven Hills Nursing Home.

People were provided with a varied and nutritious diet. People told us they enjoyed the food at Seven Hills Nursing Home.

Care plans contained person centred information which meant staff had personal and medical information available to them to ensure the person was supported in the way they preferred to meet their health and social care needs.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure procedures were adhered to. Where any problems were identified the registered manager took action to resolve them.

Everyone told us that the registered manager was approachable. Resident and staff meetings had been held in the last six months.

The service did not always follow the requirements of the Mental Capacity Act 2005 Code of Practice and Deprivation of Liberty Safeguards as not all people’s care plans clearly recorded whether the person had the capacity to make significant decisions about their care and treatment.

This is a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014, need for consent. You can see what action we told the provider to take at the back of the full version of the report.

We were not able to speak with most of the people using the service because they were unable to communicate verbally with us in a meaningful way and we used a formal method to observe people. We observed staff explaining their actions to the people and gaining consent.

People spoken with told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice. The examples they gave included choosing when to get up and go to bed, what to wear and what to eat. They were also satisfied with the care they had received. Their comments included: “everything is really good, the food is excellent” and “staff are marvellous you cannot fault them”.

We spoke with four relatives who were satisfied with the quality of care their family member had received. Their comments included: “I like it because it is a small care home and there is a calm atmosphere” and “the staff listen to him when he (family member) has something to say”.

We found that the home had processes in place to make sure equipment was suitable for its purpose, was available and properly maintained.

The service had effective recruitment and selection procedures in place and where necessary ensured that staff were registered with the relevant professional body.

Comments and complaints people made were responded to appropriately.

People with dementia are not always able to tell us about their experiences. Therefore we have used a formal method to observe a person which is known as the Short Observational Framework for Inspection (SOFI). This involved us observing people who use services for a period of time and recording their experiences at regular intervals.

Our observation on the day concluded that people were supported by the staff in promoting their independence and they were involved in their care. We observed staff explaining their actions to the people and gaining consent. People were happy and co-operative with the staff.

Relatives who spoke with us said that they were involved in identifying people’s needs and in the planning of care. Two people told us that they saw the GP if they felt ill. One person said,” I am alright here. I get looked after.”

People looked comfortable and contented. We asked people whether they felt safe living in the home and whether they were worried about anything. Three people said that they were happy in the home and the staff were good. One person said, “People off the street could not get in because they have to get the staff permission to enter the home.”

People could not remember having been involved in residents and relatives meetings, but two relatives told us that there had been meetings. They also told us that there was to be a general refurbishment planned.